Question

A 55 year old male shortly after finishing a marathon became confused, dizzy, extremely weak and began to cramp. He immediately began to drink water but did not improve, instead he suddenly collapsed without becoming unconscious. The nurse on the scene assessed the patient’s condition and concluded that he was severely dehydrated. She proceeded to give him 1000 mL of D5W intravenously. The patient did not improve, instead he began to have a seizure so he was immediately taken to the hospital. At the hospital a blood panel was ran and it revealed that he was severely hyponatremic. Medical history also revealed that the patient suffers from chronic hyperglycemia (diabetes), adrenal insufficiency, lactose intolerance and high blood cholesterol. He was treated with hypertonic saline (3% NaCl) and a diuretic. He recovered within 24 hours.

1. What mistake did the nurse make that lead him to have a seizure? Explain.
2. What information about the patient's medical history could have helped the nurse? Why?
3. Why was he given hypertonic saline?
4. Why was he given a diuretic?
5. How should have the nurse initially treated him to prevent him from having a seizure? Based on the information she had.

Answer 1

What mistake did the nurse make that lead him to have a seizure? Explain.

It could be that the nurse was not aware of the patient's history which is that the patient is suffering from chronic hyperglycemia (diabetes) and this could have caused the patient to become hyponatremic. It is seen that his medical history also revealed that the he suffers from chronic hyperglycemia (diabetes), adrenal insufficiency, lactose intolerance and high blood cholesterol.

We should be very careful when giving D5W (Dextrose 5 in water) to a diabetes patient Dextrose should be carefully given to people who have diabetes, because they might not be able to process dextrose as quickly as would someone without the condition. Dextrose can increase the blood sugar too much, which is known as hyperglycemia. Hyperglycemia related epileptic seizures can be diagnosed when high blood glucose accompanied with normal plasma osmolality and negative urine ketone occurs. Seizures are initial symptoms of severe hyperglycemia.

What information about the patient's medical history could have helped the nurse? Why?

The nurse should have been made aware that the patient is a diabetes patient and also that giving dextrose to the diabetic patient could be harmful.

Why was he given hypertonic saline?

A single dose of 100-150 mL of hypertonic 3% saline can be given to stabilize severe hyponatremia. Vaptans ( nonpeptide vasopressin receptor antagonists also known as VRA) appear to be safe for the treatment of severe hypervolemic and euvolemic hyponatremia but should not be used routinely.

Why was he given a diuretic?

Diuretics are water pills. Diuretics along with hypertonic saline (3% NaCl) will help the patient to come out of the severe hyponatremia condition.

How should have the nurse initially treated him to prevent him from having a seizure? Based on the information she had.

NS (Normal saline) or DNS (Dextrose Normal Saline) could have been used to help the patient stabilize from the dehydration condition by the time all the patient's history or tests samples are collected for further investigation. IV solutions containing strong doses of glucose are not recommended for diabetic patients and the nurse was not aware that the patient is suffering from diabetes.